Larry Jones: Understanding the Affordable Care Act

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Posted Mar. 11, 2014 at 12:01 AM

Posted Mar. 11, 2014 at 12:01 AM

There is still much talk going on about the Affordable Care Act (ACA), the Missouri Health Insurance Marketplace, and what they mean to you. For some, there may still be some confusion about it as well. One thing is clear – March 31 is the deadline to sign up for insurance under the ACA. Those who miss the open enrollment deadline will have to wait until 2015’s open enrollment period to access coverage, which will not be until the end of this year.

Health insurance coverage is becoming a requirement, but the new law has some subsidies to help cover the costs.

Middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.

The subsidies you may receive depend on age, number of dependents, number of people in your family, and income, among other things. A good tool to estimate possible subsidies is through the Henry J. Kaiser Family Foundation and can be found at: http://kff.org/interactive/subsidy-calculator/.

In states that opt out of expanding Medicaid, some people making below this amount will still be eligible for Medicaid, some will be eligible for subsidized coverage through Marketplaces, and others will not be eligible for subsidies.

You may be wondering what counts as coverage. According to the ACA, you already have acceptable insurance if you have a health insurance plan offered through your job; COBRA or retiree coverage; insurance bought on your own; Medicare; Missouri’s Medicaid program or Children’s Health Insurance Program; TRICARE; or Veterans Affairs health care.

You can apply for insurance through the ACA online, by phone, or in person. The five steps for applying online are visit www.healthcare.gov; create an account; fill out the application; compare plans; and get covered.

There are a few things you need to have available before going online to search for coverage, which include:

• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements). Many people using the Marketplace will qualify for lower costs on monthly premiums or lower out-of-pocket costs;

• Policy numbers for any current health insurance plans covering members of your household; and

• A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for (you’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in).

If you would like to apply in person, there are a few places you can go in Independence for help:

• For help and to apply over the phone, the Federal Health Insurance Marketplace toll-free call center is available 24/7 at 1-800-318-2596.

There are a few exceptions to the timeline of only enrolling during the Open Enrollment period, and involves a qualifying life event. This would allow you 60 days after the occurring event to sign up for insurance. A qualifying life event includes (but is not limited to) a marriage or divorce, having or adopting a baby, moving to a new state or new area that offers different health plan options, certain changes in your income, or losing other health care coverage.

Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage.

Other than a qualifying life event, you can purchase Marketplace health insurance only during the annual Open Enrollment period.

The second exception is with Medicaid or the Children’s Health Insurance Program (CHIP) in your state, which can be enrolled in at any time. Medicaid and CHIP provide health coverage to millions of families with limited incomes. You can find out if you qualify for Medicaid or CHIP by filling out a marketplace application or going directly to your state Medicaid agency.

Some Americans will be exempt from the requirement to buy insurance. The exemptions include if:

• You are part of a federally recognized religion that prevents you from accepting insurance benefits;

• You are a member of a recognized health care sharing ministry;

• You are a member of a recognized American Indian tribe;

• You are an undocumented immigrant;

• You are in jail or prison;

• You are not required to file federal income tax because your income is below the filing level; or

• You don’t have an affordable health insurance option available, which means that health insurance would cost more than 8 percent of your income or you would have qualified for Medicaid if Missouri had chosen to increase eligibility (an income below $15,850 and a family of four with income below $32,500).

Anyone who does not have coverage by April 1, 2014, will face a penalty of $95 or 1 percent of their annual income for failing to comply. This can be a complex and confusing topic, but hopefully this will help you understand a little bit more about what the ACA requirements are for you, and, if applicable, help you get signed up for the insurance you may need.

Page 3 of 3 - Larry Jones, MPH, is the director of the Independence Health Department.